May 29, 2023

Dr. Aly discusses the medication Xanax (Alprazolam) and answers your most common questions about Xanax’s uses, dosing, side effects, and withdrawal! ***Link to Dr. Aly’s FREE “Antidepressants: A Beginner’s Guide” ➡️

Xanax is one of the most commonly prescribed benzodiazepines for anxiety and over 17 million prescriptions are written for it each year so in this video we’re gonna break down the must know facts about this medication so that you can be better informed when deciding whether or not to start it and believe me this is going to be one of those videos where you’re

Going to want to stick around the end because i’m going to give you my unfiltered opinion about this medication so xanax was first approved for medical use in the united states in 1981 so it’s been around for quite a while now and the first thing i need you to know about this medication is that it goes by two different names and doctors will often use these

Names interchangeably so xanax is the brand name and alprazolam is a generic name now how does this medication work xanax is considered to be a benzodiazepine and sometimes people will also refer to it as an angiolytic or sedative it works by calming down certain parts of the brain that become too excitable in people with anxiety and specifically it works on the

Neurotransmitter gaba so what does xanax treat well it’s fda approved in adults for the short-term treatment of generalized anxiety disorder and panic disorder it’s not approved for the use in kids and some off-label uses include other types of anxiety disorders such as maybe social anxiety or anxiety affiliated with depressive disorders it’s also commonly used off

Label for premenstrual dysphoric disorder insomnia acute mania acute psychosis and catatonia okay now let’s talk about the different formulations and how it’s dosed the immediate release and extended release tablets are the most commonly prescribed however xanax is also available as an oral solution or as a dissolvable tablet so when dosing the immediate release

Version the starting dose is generally between 0.25 to 0.5 milligrams one to three times daily and this dose can be increased every three to four days and the max dose is four milligrams if being used to treat generalized anxiety in one milligram if being used for panic for the extended release version dosing starts at one milligram per day and the max dose is

Between four to six milligrams daily now it’s important to remember that the goal is to find the lowest effective dose and to use this medication for the shortest period of time so a big question that i’m commonly asked is how long does it take for this medication to start working and i get it because if you’re someone who is having a panic attack you want these

Symptoms to go away immediately xanax is one of the fastest acting benzodiazepines and it reaches peak concentrations relatively quickly however the caveat to this is that it also has a short duration of action so basically what this means is quicken and quick out and this sucks for a lot of people what we see is that in the moment symptoms of anxiety are managed

Really really well however it’s only a fleeting and temporary improvement because with it leaving the system so quickly patients often have breakthrough anxiety between doses and sometimes this anxiety is worse than the original anxiety that you had prior to taking the medication then what we see is a snowball effect right because that rebound anxiety pops back

Up again and is worse in severity and then what you’ll want to do is take another xanax and then this happens over and over again and before you know it you’re taking more medication than it’s being prescribed you and your risk of becoming addicted and dependent skyrockets and then when you realize you’re struggling with xanax use or abuse and you want to come off

Of it you’re at high risk for withdrawal symptoms which will be discussed more in a minute but first let’s talk about potential side effects the most commonly reported side effect of the benzodiazepine class as a whole is drowsiness and this occurs in about 10 of people other commonly reported symptoms from xanax include slurring of words impaired coordination

Forgetfulness and memory impairment decreases in blood pressure and changes in sex drive one of the most serious side effects is its potential to cause respiratory depression and death and this is especially true if you’re taking xanax with opioid medication there’s actually a big bold warning on the fda label that states that use of benzodiazepines and opioids

Together may result in profound sedation respiratory depression coma and death there have been observational studies that have demonstrated that mixing opioids and benzodiazepines increases the risk of drug related mortality compared to the use of either alone another big thing to take into consideration is that xanax has a high risk of abuse misuse and addiction

And this can lead to overdose and death as well remember benzodiazepines are scheduled for controlled substances xanax can also put people at high risk of falls particularly the elderly and it can cause paradoxical reactions where instead of the medication calming you it can actually make you more irritable agitated or aggressive then you also have to be cautious

When taking these medications if you’re driving because benzodiazepines can cause impairments and coordination and mental alertness now how long should someone be on xanax for the goal with this medication is to be on it for the shortest duration as possible so it’s not uncommon for people to take it for only a few weeks this allows a primary medication such as

An ssri to build up in the system and to cause the nervous system to become less excitable or it allows someone to get therapy started and learn new ways to cope with anxiety just remember it’s not known if xanax is safe and effective when used to treat generalized anxiety for longer than four months or panic disorder longer than 10 weeks so how do you come off

Of this medication this is one of the most important topics that i need you to know about you’re at high risk of experiencing withdrawal symptoms with dose reductions if you’re someone who is on a higher end dosing wise or if you’re someone who’s been taking this medication for a long time and mild symptoms of withdrawal can include things such as diarrhea muscle

Cramping and twitching decreased appetite blurred vision clouded sensorium and heightened sense of perception however the biggest thing you need to know is that abrupt discontinuation or rapid dosage reductions can produce seizures and life-threatening withdrawal reactions so we need to taper this medication very slowly okay the fda label states that the dose

Of xanax should not be decreased by more than 0.5 milligrams every three days however okay in my clinical experience this is way way too fast for most people and at most i’ll generally do around a ten percent reduction every few weeks and i’ve even gone as low as one percent dose reductions i cannot stress the importance enough of making sure to work with your

Doctor when you decide to come off a xanax okay so now you’re wondering what are my thoughts about this medication so what i’m gonna tell you is that this medication is easily in my top three psych meds that i dislike the most okay the mechanism of it being quick in and quick out makes it really unappealing because of those breakthrough symptoms of anxiety that

We talked about earlier it can be highly addictive right even for people who don’t have a history of substance abuse issues and not only that the side effect profile of it just kind of sucks right because if you’re someone that’s looking to be functional when it comes to work performance or the ability to learn new information say if you’re a student right you have

The issue of memory impairment and it interferes with your ability to learn new things and if you’re someone who’s more prone to having big emotions it can be really disinhibiting and cause you to be more reactive so we’re talking more aggressive symptoms more agitation and more irritability and then on top of that if you’re elderly you have at least a 50 percent

Greater risk of falling you shouldn’t drive when taking it because you can get a dui and then the list goes on and on so in my opinion this is one of those medications where the risk outweighs the benefit for the vast majority of people frankly if they just stopped making this medication i’d be completely fine with it because there are a ton of bender options and

Alternatives out there now if you’re looking to learn more about a safer medication option to treat symptoms of anxiety make sure to click that top video

Transcribed from video
PSYCHIATRIST Reviews Xanax (Alprazolam) For Anxiety By Straight Talk Psychiatry